Traditional Chinese Medicine Complements Psychoanalysis
Jay Abel-Horowitz, M.D.
Traditional Chinese medicine has 3000-year-old roots, but this ancient practice has enjoyed an increasing popularity in America since Nixon’s visit to China and Western doctors’ subsequent discovery of the efficacy of acupuncture. The crescendo of interest in alternative and complementary medicine in the last decade has catapulted Chinese medicine even further into mainstream awareness. Psychoanalysis and traditional Chinese medicine may seem like the proverbial apples and oranges, but in actuality they are usefully complementary. In fact, Leon Hammer, one of the foremost Western teachers of Chinese medicine in America today, is a psychoanalyst. Hammer has drawn a number of comparisons between the two. More than that, he writes that psychoanalysis and Chinese medicine have more in common with each other than either does with Western medicine.
To begin with, the primary concern of both psychoanalysis and Chinese medicine is the unique physical and emotional state of the individual. Both psychoanalysis and Chinese medicine have systematic classifications of disease and diagnostic and treatment modes emphasizing the distinguishing intrinsic attributes of each individual. Treating signs and symptoms without reading in them the story of the person is a denial of the role that the person plays in his own disharmony. To understand the disease, one must understand the person. In contrast, in Western medicine we diagnose the disease and not the person.
Both psychoanalysis and Chinese medicine focus on the root cause of imbalance. Relief of symptoms is not at the heart of diagnostic perspectives nor of overall treatment strategies. While symptom relief is humanitarian and helps to free the patient’s energies for greater participation in healing, this is only the beginning. The overall goal is a deeper rebalancing of the conflicts, deficiencies, and excesses that produced the disharmony in the first place and render the patient susceptible to future difficulties. This is a larger, more integrated perspective than is extant in the Western medical world.
Both psychoanalysis and Chinese medicine recognize that there is an underlying character structure and that symptoms occur within that context. Both understand the necessity of dealing with this underlying character in order to achieve meaningful healing. Characterologies have been a cornerstone of psychoanalytic thinking that can help the analyst organize, empathize, and understand the nature of a patient’s distress. Thousands of years ago the Chinese described characterologies and placed them squarely in the center of the etiology of disease.
Lastly (and this is not an exhaustive list), both Chinese medicine and psychoanalysis acknowledge the importance of the healer in the healing process. In Western medicine the patient is considered to have an imaginary illness – is considered not to have been ill – if the personal presence or activity of the healer has a direct consequence on the course of the disease. In both psychoanalysis and Chinese medicine there is no separation between the artisan and the tool. Both the conscious and unconscious intentions of the practitioner are energies capable of profoundly interacting with the energy of the patient for better or worse.
Chinese herbs or acupuncture can be used as an adjunct to psychotherapy in selected patients who might otherwise be placed on medications for anxiety or depression. In that regard, the treatment can be focused more selectively than Western anxiolytics or antidepressants because it is directed at the specific imbalances that are idiosyncratic to that particular individual. In addition, there are at least two aspects of traditional Chinese medicine that are wonderful complements and enrichments to psychoanalysis. The first of these pertains to psychosomatics; the second, to characterologies.
During the Middle Ages, the church had totalitarian control over scholarly activity. It gave its imprimatur to the earliest development of medical science with a proviso. It defined and limited the subject of study that scientists could pursue. The body could be the subject of scientific investigation, but the spirit was to remain the domain of the church. With this, Vesalius was allowed to pursue medicine’s earliest anatomic dissections circa 1543. Seventy-five years later, Descartes framed this division of labor in his influential philosophy, in which he articulated this mind-body split as a fact of reality. It has been set in stone in our culture ever since, with the result that many great minds have tried to understand how mind and body communicate. Numerous scholarly articles have been written trying to understand and heal this divide. Freud himself pondered what he called “the mysterious leap between mind and body.” In our technological age, so full of mechanical and electronic wizardry, we regard ourselves mechanically as well. Enculturated to organize our experience in keeping with Descartes’ “ghost inside of the machine,” we perceive our bodies as separate from our minds and the material world as split off from spirit. This has fostered widespread cultural alienation as has been embodied by existentialist philosophy. We take for granted that angst is a part of the “modern age.”
The Chinese never underwent such a philosophical schism. In their culture, the mind-body never split. For them, mind and body have remained united. A search of the psychoanalytic literature produces a handful of articles wrestling with this. For some authors the Chinese purely somatize their affects. My teachers of Chinese medicine have taught me to think of this not as somatization, but as a very different way of processing experience that is psychosomatic and somatopsychic all at the same time – not meaning the disease is imaginary, but psyche and soma are experienced as inextricably linked. In Chinese medicine and in general Chinese parlance, organ disharmonies imply both psychological and physical states. This is really not so foreign a concept as it sounds at first. A small, but familiar aspect of this can be appreciated when we consider that all emotions have physical components; we just tend to underplay the physical aspect of emotion. And when we do notice the physical aspect particularly, we may have a tendency to isolate it from the emotion to which it connects.
The beauty of Chinese medicine is that they have developed a systemized description of body-mind processes. They say that “where Qi (pronounced Chi) goes mind goes.” The traditional Chinese physician is taught to monitor the ebb and flow of Qi – a basic body constituent – and its permutations. Though applied to the host of medical problems that can present to a general practitioner, the psychoanalyst can also usefully apply this science. By learning the language of this movement and how it comes to be embodied, one can develop a powerful perspective for understanding and working psychoanalytically (or with herbs and acupuncture) with psychosomatic illness (in the Western sense of the term), with the transient, though sometimes intense somatic experiences that can develop during an analysis, as well as with what might be called the “psychosomatics of daily life.”
The characterologies of Chinese medicine are another of its component parts that can benefit the psychoanalyst. These character types are descriptions of what an analyst might call the neurotic lens. Based on constitution and experiences of the early years, the Chinese describe consistent styles of distorted construction of meaning that shapes further development in a kind of feedback loop. This is very close to the analytic concept of character. These character types can be employed by the analyst. Listening to the patient’ associations, the centrality of one of these organizing principles can be tested against clinical experience with the patient and used to help shape the language of the analyst’s interventions to be more deeply resonant. Once identified, I have found it useful to follow the implications of these character types in framing my words and have often been surprised to discover important new terrain in the patient’s inner world that my personal inclinations had otherwise blinded me to. Understanding these character types can also suggest a more varied perspective on what healthy psychological functioning is. They suggest colorations to the concept of the well-integrated or “genital” personality and can thus help to define reasonable expectations for the end-point of treatment.
(Dr. Horowitz practices psychoanalysis, psychotherapy, acupuncture and Chinese herbal medicine.)